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Update from the

University of Pennsylvania Special Task Force on Rethinking the

System of Survival for Sudden Cardiac Arrest:

Allan Braslow Visiting Scholar

Our Best Practices Our Best Processes

Disclosures Univ. of Pennsylvania: I am a visiting scholar in Organizational Dynamics, and a member of Special Task Force on Reframing the System for Survival for Sudden Cardiac Arrest. Goodman Research Group: I have been a Co-PI for evaluations of AHA, ARC and NSC emergency care programs [funded by AHA, ARC and NSC]. Braslow & Assocs. I co-invented and defined in the literature: Video-Directed, Self-Instructional (VSI) CPR practice-while-watching learning method [funded by Laerdal].

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Outline for this morning...

± Who we are . . .

± Our Processes ° Thinking Systemically vs Thinking Analytically

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Who we are . . .

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A social systems laboratory that is “rethinking the system for sudden cardiac arrest survival” with interdisciplinary representatives from medical and organizational groups and societies, device manufactures, hospital and EMS systems, academic departments, and other stakeholders.

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Task Force Question

Why after 40 years of enormous energy and resources is the Sudden Cardiac

Arrest (SCA) survival rate low, very low—too low?

Are we doing the “right” things?

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•  Anthropology •  Design and

Planning •  Economics •  Education •  Engineering •  English •  Government •  Health Care •  Humanities and

Languages

•  Human Resources

•  Law •  Management •  Organizational

Science •  Philosophy •  Political

Science •  Psychology •  Sociology

We have a 35-year international track

record of success in business, industry,

healthcare and government using

Systems Thinking (Thinking Systemically).

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We deal with Wicked Problems (Messes)

Organizations that have applied

Penn's Thinking Systemically

Approach

to Dissolve Messes

and Improve Outcomes:

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American Airlines AMA ALCOA ARMCO Latin America Anheuser Busch AT&T Bell of Pennsylvania The Boeing Company Briggs and Stratton Canadian Pacific Chrysler Dubai government Dupont Eastman Kodak Eli Lilly EPA

Exxon Federal Reserve Bank Ford Motor Company General Electric General Motors IBM Imperial Oil Canada IRS Johns Hopkins Hospital Kaiser Permanente Koop Foundation Marriott International Metropolitan Life Mexico City govt NASA/Goddard and JPL NIH Natl Library of Medicine

Natl Science Foundation Oracle PanCanadian Petroleum Pentagon Sun Microsystems Southwest Airlines Union Carbide UK Health Service US Air Force US Army US Navy US Steel White House

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What is Thinking Systemically ?

± Thinking Analytically

± Thinking Systemically

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Thinking Analytically

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Thinking Analytically is a way of Thinking about a Problem

1.  The problem is in the parts, so

break it down (analyze)

2.  Search for a root cause

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Thinking Analytically is a way of Thinking about a Problem

3.  Replace or fix the bad part

4.  Problem solved!

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Similarly...

But... is it that simple?

Issues/Limitations with Best Practices

± Generally, a best practice focuses on 1 element or procedure. But ramping up one element does not necessarily have positive impact on the whole system; rather, it can have no or negative impact.

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Issues/Limitations with Best Practices

± Generally, if you find a procedure (or BP) that works in one community and is said to work in another community – upon inspection you find that the BP in the second community has 10-20 or more steps added to it to accommodate it (to make it work) in the other community.

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Issues/Limitations with Best Practices

± They are imposed, made to fit

± Sustainability?

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Thinking Systemically

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Thinking Systemically is Another Way of Thinking about a Problem: Different

Assumptions

1.  The problem cannot be broken

down into parts.

2.  You have to search and

understand the forces outside

the problem.

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Thinking Systemically is Another Way of Thinking about a Problem

3.  You have to understand how

the whole system is currently

designed; how it functions or

fails to function as desired.

4.  Create a redesign

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± In Thinking Systemically, the System is the entire community with all its subsystems, organizations, users and stakeholders.

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•  This is not a system. The Chain of Survival is a metaphor (or some refer to it as an algorithm or an additive process).

•  The system that brings about a positive or negative patient outcome is more than this.

•  The "links" above are sort of end-points in a whole series of things that need to come together.

Smoking Heart Disease

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Smoking Heart Anxiety (+) Reduces

(-) Hardens

(-) Desire to Repeat

(+) Short-term

Good for

Lungs Oxygen

(-) Negatively

Affects

(-) Negatively

Affects

Weight

Systemic Relationship Between Smoking and the Heart

(-)

(+/-)

Maintain

Blockage

Blood Pressure

Cholesterol Coating

(-) Arteries Oxidation

Negatively Affects

(-) Increases

(-) Produces

Negatively Affects

(-) Increases (-)

(-)

Defensive Action/Increases

Other Risks or Experiences

Genetic

Predisposition

Genetic Predisposition

Exercise

(-) Negatively

Affects (-)

Negatively Affects/Reduces

(-) Limits

The system for survival for SCA is a complicated system

and differs from community to community.

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± Each community has a different culture(s), work ethic, financial resources, governance, politics, socioeconomic conditions, psychology...

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The system for survival for SCA is a complicated system

and differs from community to community.

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± Each system is looked at as unique (different from the system in the next county or state) – which is how it really is in the real world.

± They don't do it like we do it.

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Approx. 19,000 Licensed EMS Agencies

Source: 2011 Natl EMS Assessment Report UNC Chapel Hill

Our Processes... Using the framework that systems are quite different/unique,

± We do not design or dictate or import the necessary changes:

The Expertise is the Stakeholder Community

The Design is Done by the Users

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Our Processes... Mess Formulation (Dx) The users, doers, stakeholders look at the whole system, the whole Mess – not parts or elements, because problems in parts are generally symptoms of a much larger system problem overall. ± An example please, Allan . . .

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Are these the real problem, or are they symptoms of the problem?

Our Processes... Mess Formulation (Dx) ± We facilitate and help figure out the problem.

± We listen to them (this is working, this is not working, etc.)

± All statements are important, but in complexity, the problem is commonly not what the org. thinks it is. The words and descriptions are too simple to fully appreciate the problem.

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Our Processes... Mess Formulation (Dx) ±  Until MF is performed, most organizations do not realize that

holding on to their original vision is contributing to their failure. Once they give up the original vision, they realize that that was the core of the problem.

±  They realize that all of the problems (symptoms) emerged from holding on to their primary vision or principle.

±  They can't see it ahead of time. They don't know what the problem is until they have kind of gone all the way through the MF.

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Our Processes... Idealized Design ± A Design Team of stakeholder/users creates

an Idealized Design to Dissolve the Problem(s) ° This means that they redesign the system so that

the problems cannot exist.

° They don't fix and solve – they redesign/alter so the problem cannot occur.

° They "start from scratch."

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Our Processes... Idealized Design ± The ID is based on what is desired if those

who are part of the problem (stakeholders) could have what they want rather than merely improving what already exists in the current state.

± AND they start with their desired outcome.

±  Backcasting (Start with what you want) Braslow

Our Processes...

And then... ± We say "Let's now figure out what we can do about it

– how closely can we approach the idealized design? And what resources do we need to approach it?

± Then the stakeholders say "In order to do these kinds of things... (and they work together to implement the design).

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Summary

± Who we are . . .

± Our Processes

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Please join us!

Google: Penn SCA Survival

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braslowa@gmail.com

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